Benign metastasizing pleomorphic adenoma in liver mimicking synchronic metastatic disease from colorectal cancer: a case report with emphasis on imaging findings

Unusual metastasizing pleomorphic adenoma of the parotid gland involving locoregional lymph nodes

Carcinoma ex-pleomorphic adenoma (PA) is a complex group of malignant neoplasms arising in PA. When microscopic features of the neoplastic cells are representative of carcinoma, the pathologist can easily make a definite diagnosis, but when worrisome morphology is replaced by metastatic behavior, the metastasizing PA (MPA) is a diagnostic challenge for the pathologist. Here, we present an unusual MPA to cervical lymph nodes and discuss diagnostic challenges.

Intraoral Pleomorphic Adenoma of the Minor Salivary Glands: A Case Series of 10 Cases With Emphasis on Histopathological Features

Pleomorphic adenoma (PA), the most common salivary gland tumor, presents unique challenges due to its diverse clinicopathologic features. The objective of this case series is to highlight the implication of detailed histopathological examination to guide appropriate diagnosis. This study reviews 10 cases of PA diagnosed at B.P. Koirala Institute of Health Sciences, Nepal, between 2011 and 2023. Patients ranged from 16 to 71 years, with a male-to-female ratio of 1:2.3. Most lesions (eight cases) were located on the palate, with additional cases, one on the upper lip and one on the cheek mucosa. Lesion sizes ranged from 1 to 3 cm2 and durations from 2 months to 4 years. Clinically, all lesions were well encapsulated, nontender, and nonulcerated and had normal overlying mucosa. Histopathologically, cases included classical PA, myxoid, and cellular types. Common findings were ductal structures filled with eosinophilic material, a "swarm bee" appearance, plasmacytoid cells, and myxoid stroma. Squamous differentiation and psammoma bodies were observed in some cases. No osseous or cartilaginous components were detected. All cases were excised, with no recurrences reported during at least 2 years of follow-up. Hence, proper diagnosis is crucial for effective management and long-term outcomes of PA.

Treatment of relapses of benign latero-cervical pathology: a narrative literature review

Benign laterocervical pathologies are not without pitfalls. Many may relapse after many years and, sometimes, they cannot be predicted. The purpose of this review is to describe the surgical measures necessary for the treatment of relapses of the most common benign laterocervical masses. We searched PubMed, Embase and Cochrane Central Register of Controlled Trials databases for articles describing the treatment of the most common benign cervical disease recurrences, and summarised available evidence in this narrative review. We overviewed observations about recurrent benign mixed tumour (pleomorphic adenoma), parapharyngeal space tumours and carotid body paragangliomas, thyroglossal duct anomalies and branchial cleft anomalies. Proper surgical technique is crucial for safely and effectively managing the relapses of benign latero-cervical diseases. Radiotherapy is indicated in several cases of recurrence such as pleomorphic adenoma and unresectable paraganglioma. Long-term follow-up is of utmost importance to promptly recognise and treat recurrencies.

A new ligand of CD105 screened out by phage display technology provides a reliable identification of recurrent or metastasizing pleomorphic adenoma from pleomorphic adenoma

OBJECTIVES

To assess CD105 expression in pleomorphic adenoma (PA), recurrent pleomorphic adenoma (RPA) and metastasizing pleomorphic adenoma (MPA), to identify new epitopes and screen a ligand with high affinity to CD105 by phage display technology, to evaluate the reliability of the new ligand for identifying RPA/MPA from PA.

METHODS

Phage display technology was used to screen ligands with high affinity to recombinant human CD105. The ligand with strongest affinity to CD105 was synthesized by FMOC Chemistry according to the sequencing results. The archived formalin fixed paraffin-embedded (FFPE) tissues of 35 PA cases, 12 RPA cases and 2 MPA cases were sliced and immunofluorescent stained. CD105 expression were detected by Confocal laser scanning microscopy (CLSM). The relative fluorescence intensity was calculated with the image processing software Image J. Statistical analyses were performed by the software Graph Pad Prism (Version 7.0a). Using PROC logistic, receiver operating characteristic (ROC) curves, area under ROC curves (AUCs) were generated to assess the sensitivity and specificity of the new ligand for identifying RPA/MPA from PA cases.

RESULTS

A ligand with specialty and high affinity to CD105 i.e. ligand nABPK296 were developed. FITC-labeled ligand nABPK296 confirmed the difference of CD105 expression in RPA/MPA and PA. The AUC of nABPK296 was 0.9418.

CONCLUSIONS

CD105 is a promising biomarker for identification of RPA/MPA from PA cases. Ligand nABPK296 provides a promising approach to CD105 detection. This study also validated the reliability of phage display technology in finding new episodes and ligands with high affinity for antigens.

Metastasizing pleomorphic adenoma in the multiple organs: A case report on FDG-PET/CT imaging

RATIONALE

Pleomorphic adenoma, the most common tumor of the salivary glands, is usually benign. It is well known, however, that pleomorphic adenomas occasionally undergo malignant transformation to carcinoma ex pleomorphic adenoma and can metastasize. More rarely pleomorphic adenomas can metastasize without histological malignant transformation. We herein report an unusual case of pleomorphic adenoma with multiple metastases comprehensively demonstrated on F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT).

PATIENT CONCERNS

A 63-year-old woman was referred to our hospital because of urine occult blood and lung nodules detected on a health checkup. She had a history of resection of a pleomorphic adenoma in the parotid gland at the age of 40 years and tumor recurrence at the age of 53 years. CT scan and magnetic resonance imaging revealed bilateral renal tumors, multiple pulmonary nodules, and an osteolytic lesion in the first lumbar vertebra.

DIAGNOSES

Ultrasonography-guided percutaneous biopsy of the right renal tumor revealed a myxoid epithelial tumor that was consistent with metastasis of the pleomorphic adenoma from the parotid gland.

INTERVENTIONS

The patient was carefully observed with regular imaging examinations.

OUTCOMES

The multiple lesions gradually progressed, and FDG-PET/CT subsequently revealed additional metastases in the liver and perineum.

LESSONS

Metastases of pleomorphic adenomas may occur years after the initial disease in association with local recurrences. Careful observation with whole-body imaging such as FDG-PET/CT is necessary.

Metastasising Pleomorphic Salivary Adenoma: A Rare Case Report of a Massive Untreated Minor Salivary Gland Pleomorphic Adenoma with Concurrent Ipsilateral Cervical Node Metastases

Salivary gland tumours constitute approximately 1-5% of all human neoplasms. Pleomorphic adenoma (PA) is the commonest benign neoplasm affecting the parotid gland most often (> 75%), followed by the submandibular gland (13%), then the palate (9%). Metastasising pleomorphic adenoma (MPA) is extremely rare. The effects can be severe and a reported 40% of MPA patients die with disease. This case represents the first known case in English literature of an untreated minor salivary gland PSA of the palate metastasising to an ipsilateral cervical node. We report a 61 year old female who presented with a large tumour occupying the palatal vault, and cervical neck mass. The oral tumour was believed to have been growing over four decades. The patient died eight months following surgical resection. Of known cases, male: female ratio is 35:51 and the mean age at diagnosis is 49.2. Most commonly, MPA is detected in bone 33.3% (n = 29), lung 31% (n = 27) and cervical lymph nodes 20.7% (n = 18). Thorough reporting is deemed essential to further understand the biological differences of non metastasising and metastasising PAs, treatment outcomes, prognosis and survival rates.

Metastasizing pleomorphic adenoma of the parotid gland

Salivary gland tumours are estimated to represent approximately 3% of all head and neck tumours. About 70–80% of these neoplasms occur in the major salivary glands, with the parotid gland being the most commonly affected site. The metastasizing pleomorphic adenoma (MPA) has histological characteristics of pleomorphic adenoma, but it has the capacity to generate local recurrences and distant metastases (mainly bones, lungs, and lymph nodes). Despite the fact that some authors consider it to be a benign neoplasia, the 2015 World Health Organisation (WHO) classification of head and neck tumours considers it to be malignant.

We present a highly unusual case of metastasizing pleomorphic adenoma of the parotid gland and a bibliographic review.

Metastasizing Pleomorphic Adenoma Case Report and Review of the Literature

Pleomorphic adenoma (PA) is by far the most common salivary gland tumor. It is well known that PA can undergo malignant transformation. However, in rare occasions it can metastasize preserving its benign phenotype. Metastasizing pleomorphic adenoma (MPA) constitutes an extremely rare tumor. Here we are reporting an unusual MPA affecting the mandible that was preceded by a submandibular gland pleomorphic adenoma.